| Bronchiolitis, mostly caused by the infection of respiratory syncytial virus(RSV), is a common infection disease of the lower respiratory tract in children. RSV can not only injure mucous membrane of respiratory tract directly, but initiate immune response as a allergen, cause immune damage if overreaction. The treatment of bronchiolitis mainly consists of antiviral, prevention of bacterial, symptomatic and supportive therapy. Glucocorticoid(GCs) are often applied in the therapy of severe bronchiolitis, but there has been no consensus on the medication of GCs in the patients with bronchiolitis.We detect the changes of ACTH, cortisol and11β-HSD in acute and recovery stages of bronchiolitis to evaluate the treatment, forecast prognosis and outcome.24cases with bronchiolitis were admitted in our hospital from Jan2010to May2011, all of which were demonstrated to be contracted by RSV through the detection of anti-RSV by ELISA. All of them met the diagnostic criteria of bronchitis elucidated by Zhu Futang practical Paidonosology.18cases (cortisol and ACTH reduce during acte period) of them were tested again in the recovery period (3days after bubble and wheezing disappeared). Another20children of health were enrolled as the control group from the health examination group. Plasma ACTH concentration was measured by Electrochemiluminescence Method. Serum cortisol level was detected by chemiluminescent immunoassay method.The levels of11β-HSD2were tested by ELISA. All of the datas were performed with SPSS16.0statistical software package.The cortisol levels of24bronchiolitis children during acute period were (81.31±98.40) nmol/L, that level of control group were (226.05±143.90) nmol/L, the difference was significant (P<0.01). The cortisol levels in recovery period were (188.01±210.94) nmol/L, the difference was statistically significant compared with it in the acute period, but that showed no statistical significance compared with the control group. The ACTH levels of24bronchiolitis children during acute period were (1.11±2.77) pmol/L. The levels of control group were (6.16±7.73) pmol/L, the difference is significant (P<0.01). The ACTH levels in recovery period were (4.54±8.62) pmol/L, and it is increased significantly than that in the acute phase. The difference is statistically significant, but that has no statistical significance compared with the control group (P>.05). There had a positive correlation between cortisol and ACTH. The concentrations of11β-HSD2of24bronchi olitis children during acute period were (28.39±6.32) ng/ml. The levels of control group were (29.89±5.63) ng/ml. the difference is not significant (P>0.05). The11β-HSD2levels of control group were (31.50±5.45) ng/ml. The difference is not statistically significant, and that has no statistical significance compared with the control group.The cortisol levels during the acute phase were decreased, and ACTH was also decreased, which was consistent with the theory that cortisol secretion was regulated by ACTH, and the level of ACTH and cortisol were parallel. We speculate that the change may be associated with the pathogenesis and pathological of bronchitis. In the acute period, the exogenous glucocorticoids can be applied to meet the shortage of the insufficient production of endogenous cortisol to develop the imflammatory action locally. Comparing with hydrocortisone, the level of ACTH is more sensitive and easily recovered, which can be used as the indication for the application of hormone in children suffered from capillary bronchitis. Cortisol levels in children with asthma were significantly lower than that of normal children, which prompted that the detection of those targets could estimate the prognosis of the children with bronchitis. The three targets of some bronchitis children didn t recover to normality. Especially as to the level of ACTH, it hasn’t yet confirmed by the follow-up results that higher level of ACTH tend to develop to asthma easier than other children. The decline of cortisol level of bronchitis may not result by the increase of11β-HSD2. |
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